The Conversation a Dentist Can Have with Fearful Patients

Here is another post, the last in a series, from our friend Jen Butler of Jen Butler Coaching.

It doesn’t matter if patients react from flight or fight mode.  Both types can be easy to work with and does not need to make for a stressful day at the office.

These steps will help you connect, defuse, and gain case acceptance.

1. Empathy- “Mr. X, you seem uneasy/unnerved. In my experience those patients are often the ones that are the most uncomfortable coming to the dentist.  How are you doing with this?” Here’s where you are going to hear, “I don’t like the dentist.”  Hard to hear as a dental professional and also NOT TRUE. Realize when a patient says, “I hate the dentist,” they aren’t talking about you.  This isn’t personal so why are you having a personal reaction? They don’t know you so how can they not like you?!  They are reflecting back on past experiences with other dentists.  This is fantastic information for you to connect with and turn this patient into a real patient for life.
2. Validation- “Mr. X, many patients like yourself share with me they don’t like going to the dentist.  I’ve learned over the years that it’s not the dentist they don’t like but the fear of having cavities, needing work, or experiencing pain that they are looking to avoid.  Would that be true for you?”  If yes, “I see.  That’s totally normal and we are here to work with you through this process.”  If no, “Then what about going to the dentist has you so uneasy/unnerved?”  Validation is the most powerful means of connecting with your patients.  It says you get them and you know how to meet their needs.  FYI- that’s priceless, tangible value for a consumer and they are willing to pay for that.
3. Clarify-  Find out what the patient knows about their previous treatment and diagnoses.  Sometimes you’ll find the patient has thoughts that are not accurate which is feeding into their irrational fear.  You can help them understand and calm their nerves by using Empowering Questions.  Examples:  “What do you know about this treatment?” “What do you remember about the diagnoses?”  “When you recall the conversation, what words pop out most for you?”
4. Fill in the gaps- When a patient recalls something with misinformation or not as you remember, don’t have an emotional reaction about it.  Chalk it up to basic functions of the brain.  It takes at least 3 times for anyone to retain new information accurately.  You are going to fill in the gaps for patients about treatment, payments, insurance, procedures, processes and systems.  It’s not them.  It’s not you.  It’s ALL OF US.  You can either have those three times be at three different appointments or all three times built into one appointment.  That choice is yours.
5. Offer solutions minus the fear-  Patients want treatment, even the fearful.  No one innately wants to have bad oral health.  Help them accept treatment by asking this important question, “If we can do something that will [blank] AND it will be pain free, will you do it?”   The power in this question is the AND.  Don’t forget the AND.
6. Offer a way out- Here is where you talk about the difference between pain and discomfort.  Not much in dentistry really hurts.  There is a lot in dentistry that is uncomfortable.  Laying with your mouth open, people poking at your gums, the notion of someone drilling into your teeth..don’t tell me that doesn’t sound uncomfortable.  It doesn’t cause pain.  Give your patients different words to think about as you proceed, questions to ask themselves during procedures, and a definite way out.  Consider saying, “As we move forward I want you to ask yourself, ‘Is this causing me pain or am I in discomfort?  If it hurts, we will stop and figure out why.  Nothing we are doing today should hurt.  If you are in discomfort we have lots of ways to make you feel more comfortable.  I just need to know the difference.  Regardless, there is always a way out.  You are in control of how fast we go and what we accomplish today.”

For more specific advice on your particular situation, email Jen or call her at (623) 776-6715

What Should a Dentist Do When a Patient Wants to Flee?

Here is another post, the second in a series, from our friend Jen Butler of Jen Butler Coaching.

Patients that come from a place of fight are easier to pinpoint, not easier to work with.  The body has a defense mechanism that when put in dangerous, threatening, or fearful situations gets louder, bigger, and more aggressive to ward off what we perceive as a dangerous predator- yes, meaning you.  I know what you’re thinking, “Patients chose to come in.  I don’t force anyone.”  Doesn’t change the reaction they have.  Remember, this is biology and physiology that is so automatic to our systems we don’t even recognize when we are in these modes.  Patients are not choosing their reaction and they are not making a conscious decision to make your life and the team’s lives miserable.

Patients that have the fight response look and sound like this:

• Move loudly throughout the office, making sure everyone knows they are there.
• Direct responses, often being borderline rude or curt (they are on the offensive).
• Appear grumpy and negative.  I refer to them as prickly- like a porcupine with it’s quills out.
• Easily jump into conflict and disagreements with anyone in the office. “Mr. X, isn’t this weather wonderful?”  “What’s so wonderful about it.  It’s so sunny out it’s blinding me!”
• Use sentence enhancers (swearing), exclamations (Darn it, ‘You’ve got to be kidding me’, etc) and name calling to deflect anyone from noticing their real feelings.

Patients with the fight response are more challenging to navigate through than their counterparts.  Patients in fight mode can be scary, uncomfortable, and mean.  It’s normal to walk away from an experience with a fight patient and need to decompress and regain your composure.  You might want to go as far as dismissing them from the practice altogether.  These are the kind of patients that take you to the brink of, “This isn’t worth it,” and walk away from everything you’ve created.

There is a way for you to: 1) not be affected by these types of patients; 2) assure them they are in a safe place; 3) have a mutually positive experience.  Start with these steps:

1. Accept the patient’s reaction.  You won’t be able to change their automatic response.  You can change their experience.  Control what you can and influence the rest.
2. Don’t come from ego.  This isn’t about you or your team.  The patient didn’t wake up in the morning and purposefully set out to ruin your day.  They are afraid.  If this were a child afraid what reaction would you have?  Why is it different because it’s an adult?Fears are irrational no matter the age.
3. Slow down and give space.  Being in fight mode comes with intense emotions and high energy.  Don’t fuel the experience further by talking fast, rushing the appointment to get through it, and matching high energy.  Slow the experience down by talking just a bit slower, move with more intention, sit lower than your patient with rounded shoulders and your hands in your lap (just until the fear has dissipated), and hang back just a few extra inches when you can to give some space.  Balance your patients energy, don’t fuel it.
4. Ask empowering questions to get the patient talking.  The more you know about them and connect, the greater the chance they will be able to share with you what’s really happening.  If they already knew how to tell you they were afraid they would have.  Help them along by asking the right questions.
5. Be honest, upfront and just ask.  If you find the patient’s fear is really getting the best of them and it is derailing the experience, be honest and just ask, “Mr. X, I’m wondering if you are nervous about being here?”  Wait and listen.

For more specific advice on your particular situation, email Jen or call her at (623) 776-6715

What a Dentist Should Do When a Patient is Fearful

Here is a guest blog post from our friend Jen Butler, M.Ed., CPC, BCC from Jen Butler Coaching.

Fear and dentistry seem to go hand in hand.  Whether the fear comes from childhood experiences or is solely psychological, fear is a real thing that patients often bring with them to their appointments.

Here’s what most dentists and their teams fail to remember: people have two biological, automatic reactions when dealing with fear, FLIGHT or FIGHT.

Those patients that are in flight mode often look and sound like this:

• Sound, they don’t make sounds, not even when asked questions. They are struggling internally to keep it together.  They also know the more conversation had during their experience, the longer they will be there.  Their goal is to get out!
• Often show a nervous twitch by moving their feet, bouncing their leg, moving their hands, etc.
• Ask, “How much longer?” or “What’s next?” or even “Are you almost done?”  They can’t wait to get to the door and RUN.
• Avoid talking about same day treatment, say they want to schedule another appointment and then don’t schedule.

Flight patients are harder to notice because they are stealthy.  Meaning, they don’t let on that they are afraid.  These patients leave you wondering ‘what’s wrong with them’ or ‘with you’ because their appointment was like pulling teeth, and not the literal kind.  You can’t help but reflect on how awkward their appointment was for you and the team.

To effectively work with people in flight mode:

1. Know the signs.  You and your team need to be able to recognize patients in flight mode.
2. Offer calming methods to reduce fear and stress (music, laughter, warm blankets, dim lighting, stress balls, show comedies, etc) if you think they are a flight patient.
3. Be assertive and ask, “I’m curious Mr. X.  How nervous are you about being here today?” The problem addressed is the problem solved.  Until the fear is addressed, the patient can’t truly listen and take in what you are saying about their oral care.
4. Demonstrate confidence in your clinical skills. So often when a patient isn’t giving off the right vibe dental teams back away, feeling awkward and it throws them off their game.  They start second guessing their movements and begin to put further psychological stress on themselves which makes everything even more uncomfortable.  Know that your training and experience has uniquely prepared you for this moment with this patient.  You know how to connect, offer painless procedures, and provide a comfortable, caring environment.  Trust in that and move on.
5. Don’t reinforce stress by talking badly about the patient, ever.  It’s normal to want to vent or release the stress of working with a fearful patient to your team.  DON’T!  The more you talk about how awkward it is to work with that patient, or how much they squirm and jump while you blow air on their teeth, or even when they don’t say two words to you the more you reinforce to you and others that it was a negative experience.  Find another way to release your stress like breathing, positive self-talk, or take a 5 minute break.  What you tell yourself you believe so be careful of what you think.

Flight patients are experiencing something very real.  As a dental professional, you want to learn how to navigate through working with this type of patient because it will make  your job and that of your team much easier.  Plus you will have less stress!

Contact Jen Butler, M.Ed., CPC, BCC at (623) 776-6715 and visit her website at Jen Butler Coaching

Is a Traditional Practice or a Group Practice Right for a Dentist?

Here is another guest post from our friend Carl Guthrie at ETS Dental.

Twenty years ago, the vast majority of dentists were solo practitioners who called their own shots and ran their own businesses. Today, group practices represent a significant percentage of the market and now provide an alternative to traditional solo practice. At this point in your career, which setting is right for you?

We have placed hundreds of dentists in both group and traditional settings. While walking a job seeker through the decision process, we consistently hear the same set of "pros and cons" offered for both settings. Here is an overview that we hope will prove helpful to any dentist considering a new position.

There are many types of group practices. For the purposes of this blog I will define traditional practices as those that have a sole practitioner or two partner doctors. Group practices include corporate groups, offices run by practice management companies, and private practices with three or more doctors.

Traditional Practice:

Pros:


• More income potential as a practice owner or partner
• Freedom to run the office as you see fit
• Freedom to pursue your own clinical interests
• Equity position is more likely

Cons:


• Complete responsibility for the practice
• Many hours of administrative work outside of clinical hours
• Balancing clinical CE with business development training
• Practice growth is your responsibility

Group Practice:

Pros:


• Limited or no administrative responsibilities
• Limited or no time required outside of office hours
• Reduced overhead could improve compensation
• Collegial setting
• Larger marketing budget
• Ability to specialize within practice
• Mentors available – clinical and business
• CE program in place
• Ability to negotiate higher fees from insurance companies
• More funds for equipment and technological upgrades
• More common to find benefits packages include group health insurance, 401K, and more

Cons:


• Less clinical autonomy
• Less or no control on business of the practice
• More colleagues to disagree with
• Quality of colleagues work reflects on you
• Less freedom to pursue niche
• Equity position less likely
• Higher staff turnover

This is certainly not a complete list of all the varying aspects of these two settings.

Contact Carl Guthrie with any questions you may have.

The Value of a Second Opinion to a Dentist

Here is another thoughtful blog from our esteemed client Dr. Don Lurie.

It seems to me that every health care professional sometimes needs to take the same advice that he gives to his patients.  "I suggest that we get a second opinion on this…"

I have written many articles regarding the beginning of our practices and continuing to retirement.  As I have said, (The Profession of Retirement, May, 2013) the new career of retirement requires planning and thought including the obvious financial requirements  and also the emotional preparation (Emotional Preparation for Retirement, March 21, 2014).  I strongly believe that preparing for retirement should start with the onset of our practices and that careful management by the proper team of advisors is essential to accomplish this.  Like with most things, we get into a routine and things just continue to function and run - timely donations to retirement funds, investments, insurance, etc... 

However, I made the mistake and took it all for granted.  Things and circumstances do change.  Health can be a factor in your planning (or lack of same), personal goals, motivations, insurance needs and many other components that combine to make our new career of retirement frightening and foreboding.  It is my hope that you can learn from my mistakes and make this transition so more calming and smooth.  I think the key word here is "transition". 

About 10 years before I retired (after 50 years), my "CEO" who really was my accountant (and the head of the Team of Retirement, August, 2013), suggested that we examine several areas of my life and practice.  He also suggested that we get a second opinion on various subjects that incorporate the business of dentistry and oral surgery.  Did we have an accurate appraisal of the worth of the practice or were we hiding our head in the sand? Do we still need to continue large amounts of life insurance or can we scale back as the age increases and other investments take over? Do we have a team in place to advise us on how to Transition the practice, think about buyers, target the buyers, bring in an associate/buyer etc? Are the investments good for the short term (while in practice) or do we need to start looking for a different quality of investment or moderate style of investment for those retirement years so that there can be some inner peace without the volatility of "the gamble"? I thought that my accountant was really so wise to suggest second opinions and it proved to me that he was the correct person for the job of CEO by being unafraid to show and share our information to an unbiased group of advisors.  It is with this vision that I was able to make even better decisions, long before retirement, to make this retirement career seamless as the time approached.  Of course, the first 6 months were an adjustment but I was ready for them.  And after that period, my life has taken on a new purpose and joy that I could only hope would be the case for everyone.   Another big area that needed a second opinion was the role of the corporate attorney.  Were our documents in order? So a review of the articles of incorporation was carried out at that time.  This also helped me in finding the attorney that I thought would be the right person at the time of transition.  This was invaluable and helped to keep that stomach-ache at a minimum.  It was just one worry that was eliminated knowing that there was the right person to turn to at the given time. Another area in transition to be considered is insurance.  Do you have the right kind of life insurance, enough or too much, malpractice insurance (enough or too much), real estate insurance if it applies and are there other insurances that your situation requires? What about HIPPA? Do you have the right IT person to help you to transition? Does he need to install systems at home to help in the transition? The list of questions goes on. 

I always made it a rule when I was in active practice, that I would not be the treating surgeon after I gave a second opinion.  I made this clear to the patient initially and reinforced it.  This gave me clearance to be more objective and to sincerely want to help both the treating doctor and the patient in solving the problem or conflict.  I followed this rule when I receive my second opinion from the outside group of advisors.  They were helpful and, more importantly, reinforced my admiration for my lead accountant.  Both groups agreed that I needed a specialist in practice transition to get to where I needed to go. 

The detail of this team was amazing including instructions to staff on what to say to the patients, how to explain what was going on, where charts would be available, etc.  Actually scripts were written so that there would be consistency among the staff when answering questions.  I cannot emphasize enough the value of scripts.  They should be used throughout your entire career. 

So I would urge you to reevaluate your situation, get that second opinion and move on, either with your original team or perhaps with the new advisors.  It may be an amazing discovery.  The goal is to make this as smooth a process as possible but you too must have an open mind and be clear about your goals.  They should be written down. Keeping a journal is a valuable tool.  Remember, "You cannot live a positive life with a negative mind."

The Team of Retirement for me was key.  Outside advisors and specialists were brought in at various stages of my career and for their efforts, I am eternally grateful.

These are just some thoughts that were on my mind regarding practice transitions and the possibility of a need for second opinion.  We are all here to help one another.  Please do not hesitate to send me you thoughts and questions.  It would be an honor to help.

More Mistakes Made and Lessons Learned next time.

Dr. Donald B. Lurie

email:  donald.lurie@att.net

Phone:     717-235-0764

Cell:         410-218-2228